Provider Demographics
NPI:1639818511
Name:DIAZ, KATHERINE (MPH, CPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MPH, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12915 SW 76TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4205
Mailing Address - Country:US
Mailing Address - Phone:786-203-7906
Mailing Address - Fax:
Practice Address - Street 1:12915 SW 76TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4205
Practice Address - Country:US
Practice Address - Phone:786-203-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist